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Extended Report
Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty: a randomised controlled trial
  1. Allan Villadsen1,
  2. Søren Overgaard2,
  3. Anders Holsgaard-Larsen2,
  4. Robin Christensen1,3,
  5. Ewa M Roos1
  1. 1Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  2. 2Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
  3. 3Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark
  1. Correspondence to Allan Villadsen, Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 52, Odense DK-5230, Denmark; avilladsen{at}


Objective To investigate the postoperative efficacy of a supervised programme of neuromuscular exercise prior to hip or knee arthroplasty.

Methods In this assessor-blinded randomised controlled trial, we included 165 patients scheduled for hip or knee arthroplasty due to severe osteoarthritis (OA). An 8-week preoperative neuromuscular supervised exercise programme was delivered twice a week for 1 h as adjunct treatment to the standard arthroplasty procedure and compared with the standard arthroplasty procedure alone. The primary outcome was self-reported physical function measured on the activities of daily living (ADL) subscale in the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires for patients with hip and knee OA, respectively. Primary endpoint was 3 months after surgery.

Results 165 patients randomised to the two groups were on average 67±8 years, 84 (51%) had hip OA and 92 (56%) were women. 153 patients (93%) underwent planned surgery and were evaluated postoperatively. There was no statistically significant difference in effects between hip or knee patients (p=0.7370). Three months postoperatively, no difference was found between groups for ADL (4.4, 95% CI −0.8 to 9.5) or pain (4.5, 95% CI −0.8 to 9.9). However, there was a statistically significant difference indicating an effect of exercise over the entire period (baseline to 3-months postoperatively) (p=0.0029).

Conclusions Eight weeks of supervised neuromuscular exercise prior to total joint arthroplasty (TJA) of the hip or knee did not confer additional benefits 3 months postoperatively compared with TJA alone. However, the intervention group experienced a statistically significant short-term benefit in ADL and pain, suggesting an earlier onset of postoperative recovery.

Trial registration ClinicalTrials NCT01003756.

  • Osteoarthritis
  • Rehabilitation
  • Treatment
  • Orthopedic Surgery

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